Transcript Oh, we’ve got some bloody good drinkers in the Northern

Aboriginal primary
health care, Early
Childhood and the
Nurse Family
Partnership and
Abecedarian
programs
Donna Ah Chee, CEO
Introduction
1. Central Australian Aboriginal Congress
2. Aboriginal Health Status in the NT and early
childhood development
3. Early Childhood: the evidence base
4. The Nurse Family Partnership Program
5. The Abecedarian Educational Day care
Program and the Congress pre-school
program
Lowitja
CAACAC Board
AMSANT
CARHDS
Children’s Services
Alukura
CEO
Deputy CEO
NACCHO
Directorate
Public Health
headspace
Social &
Emotional
Heath
Remote
Health
Services
Childcare
Health Education &
Training
Ingkintja
Congress Urban Unique Clients: Health
Service Area and Visitors
Unique Congress Urban Clients
12000
Number of Clients
10000
8000
Visitors
6000
Health Service Area
4000
2000
0
2007
20072008
2008
20082009
2009
20092010
2010
Year
20102011
2011
20112012
2012
20122013
Congress Episodes of Health Care (all)
Congress Urban Episodes of Care
120000
100000
Year
80000
60000
Number of Episodes
40000
20000
0
2007 2007- 2008 2008- 2009 2009- 2010 2010- 2011 2011- 2012 20122008
2009
2010
2011
2012
2013
Number of Episodes
Aboriginal
Health
Status in the NT
and Early
Childhood
COAG Reform Council report. Healthcare 2011-2012: Comparing performance across Australia. May 2013
COAG Target 1: Life expectancy
Life expectancy at birth, by Indigenous status, sex and
selected state/territory, 2005–2007
100
Years
80
79
70
75
83
79
68
83
83
79
74
65
81
76
70
69
62
79
67
83
73
60
40
20
0
M
F
NSW
M
F
M
QLD
F
WA
Indig.
Non-Indig.
M
F
NT
M
F
AUS
COAG Target 1: Life expectancy
Main causes of Indigenous mortality, NSW, Qld, WA, SA and NT, 20042008
30
27
18
Percent
20
15
10
8
8
Diabetes
Respiratory
0
Circulatory
disease
Cancer
External causes
Australian Early Development Index
NAPLAN Year 3 Reading
Early Childhood:
The Evidence base
“Babies are born with 25 per cent
of their brains developed, and
there is then a rapid period of
development so that by the age
of 3 their brains are 80 per cent
developed.”
Ref: Allen G. Early Intervention: The Next Steps. An Independent
Report to Her Majesty’s Government. HM Government, UK. Jan
2011. http://www.dwp.gov.uk/docs/early-intervention-next-steps.pdf
“A child’s development score at
just 22 months can serve as an
accurate predictor of
educational outcomes at 26
years.”
Ref: Allen G. Early Intervention: The Next Steps. An Independent
Report to Her Majesty’s Government. HM Government, UK. Jan
2011. http://www.dwp.gov.uk/docs/early-intervention-next-steps.pdf
Evidence is
clear that
nutrition and
experiences in
the early years
of a child’s life
influence the
infant’s brain
development.
“In the brain, the ability to hold onto and work with
information, focus thinking, filter distractions, and switch
gears is like an airport having a highly effective air traffic
control system to manage the arrivals and departures of
dozens of planes on multiple runways. Scientists refer to
these capacities as executive function and self-regulation—a
set of skills that relies on three types of brain function:
working memory, mental flexibility, and self-control. Children
aren’t born with these skills—they are born with the potential
to develop them”.
Healthy development
Child has experiences in early life
that enable development of
regulation. Child becomes less
dependant of external figure (ie
parent) to regular emotions and is
able to manage challenges without
emotional breakdown or physical
outburst
Unhealthy development
Child does not have experiences in
early life that enable self regulation
in adult life. Functioning is never
developed to the extend that
emotions and impulses can be
managed. Individuals who do not
have regulation display problems in
later life such as alcohol abuse,
mental health problems, impulse
control that require control by
external systems including
legislation and agencies such as
police and mental health services
Regulation needed by other
Capacity for regulation by self
Regulation needed by other
Capacity for regulation by self
Development
Major longitudinal study 2011
www.pnas.org/cgi/doi/10.1073/pnas.1010076108
Followed a cohort of 1000 children from birth to age 32
96% retention, Dunedin, New Zealand
The California Adverse Childhood
Experiences Study
• Links between childhood maltreatment and later life
health and well-being.
• 17,000 participants.
• Adults who had adverse childhoods showed higher
levels of violence and antisocial behaviour, adult
mental health problems, school underperformance
and lower IQs, economic underperformance and poor
physical health.
• The scientific rationale for Early Intervention is
overwhelming
Anda RF, Felitti VJ, Walker J, Whitfield CL, Bremner JD,Perry BD, Dube
SR, Giles WH (2006) The enduring effects of abuse and related adverse
experiences in childhood: A convergence of evidence from neurobiology
and epidemiology. European Archives of Psychiatry and Clinical
Neuroscience 256(3): 174–86.
Negative
experiences in
the early years
have longlasting effects
that can be
difficult to
overcome later.
Ref. McCain MN, Mustard JF. Reversing the real brain drain: Early Years Study- Final Report.
Ontario Children’s Secretariat 1999. pp25-26
Hart and Risley in Shenk, D, the Genius in All of
Us, Doubleday, 2010
“ The differences were astounding. Children in
professionals' homes were exposed to an average of
more than fifteen hundred more spoken words per
hour than children in welfare homes. Over one year,
that amounted to a difference of nearly 8 million
words, which, by age four, amounted to a total gap of
32 million words. They also found a substantial gap in
tone and in the complexity of words being used “
In addition there were 560 000 more positive
affirmations in the professional households
compared with 150 000 more negative affirmations
in the welfare households
Mothers’ Speech and Infant Vocabulary
Ref: Huttenlocher et al, Developmental Psychology, (1991)
Audible television is associated with
decreased exposure to discernible
human adult speech and decreased
child vocalizations.
These results may explain the
association between infant television
exposure and delayed language
development.
Ref: Christaki DA et al. Audible television and decreased adult words, infant vocalizations,
and conversational turns. Arch Pediatr Adolesc Med. 2009;163(6):554-558.
“What parents do is more
important than who they are.
Especially in a child’s earliest
years, the right kind of parenting
is a bigger influence on their
future than wealth, class,
education or any other common
social factor.”
Ref: Allen G. Early Intervention: The Next Steps. An Independent
Report to Her Majesty’s Government. HM Government, UK. Jan
2011. http://www.dwp.gov.uk/docs/early-intervention-next-steps.pdf
Key Initiatives For Health Improvement
Population
Parenting
Programs
Immunisation
Home Visiting
Smoking
Prevention/
Cessation
School Connectedness
Early Educational
Infant Day-care
Maternal
Education
Breastfeeding
Community Development
Conception
years
Birth
2 years
5 years
12 years
Advocacy - enhance social, political, economic and physical environment;
legislation (eg. seatbelts), structural changes (eg housing design)
18
NURSE FAMILY
PARTNERSHIP’S
THREE GOALS
1. Improve pregnancy
outcomes
2. Improve child health and
development
3. Improve parents’ economic
self-sufficiency
TRIALS OF PROGRAM
Elmira, NY
1977
Memphis, TN
1987
Denver, CO
1994
N = 400
N = 1,138
N = 735
•
Low-income
whites
•
Low-income
blacks
•
Large portion of
Hispanics
•
Semi-rural
•
Urban
•
Nurse versus
paraprofessional
visitors
CONSISTENT RESULTS ACROSS
TRIALS
 Improvements in women’s prenatal health
and dramatic reduction in arrests, convictions
and jail
 Reductions in child abuse, mortality and
children’s injuries
 Fewer subsequent pregnancies and greater
intervals between births
 Increases in fathers’ involvement
 Increases in employment and reductions in
welfare dependency
 Improvements in school outcomes
 Less addictions, sexual partners and a
healthier lifestyle at age 15
NFP at Congress
• 6 nurse home visitors and 3
Aboriginal community
workers
• Recruitment has not been a
problem
• Need to present prior to 28
weeks
• 140 births per year
• 70% acceptance rate higher
for first time mothers
• Increasing early
presentations
• Reduction in smoking and
enhanced language
development in children
The Home Visit / Domains
• Mother is visited by the same Nurse Home Visitor and throughout the program
(therapeutic relationship, linked to outcomes).
• Frequency is between weekly and bi-weekly (potentially over 60 visits)
• Content of visits is prescribed (Pregnancy, Infancy and Toddler NFP guidelines)
The 6 program domains:
1. Personal Health (e.g. access to ANC, substance use, nutrition, mental health)
2. Environmental Health (e.g. safety around the home)
3. Life Course Development (e.g. resume schooling)
4. Maternal Role (e.g. physical and emotional care of baby, parenting)
5. Family and Friends (e.g. building strong net works)
6. Health and Human Services (e.g. housing)
Congress Nurse Family Partnership
38
NFP: Outcomes for 213 accepted
clients
39
40
Washington State Institute for Public Policy
Economic Analysis
Nurse Family Partnership produced
large return on investment:
– Implementation costs
– Benefits
– Return on investment
$9, 118
$26, 298
$17, 180
*Benefits and Costs of Prevention and Early Intervention Programs for Youth,
S. Aos, et al.. Washington State Institute for Public Policy: Olympia, WA, 2004.
The Abecedarian Approach
• Learning Games: Teachers daily engage in short
interactive sessions (adult/child interaction games) with
individual children or very small groups (e.g., 2 children).
• Conversational Reading: Teachers use a 3S strategy to
read a book individually every day to every child.
• Language Priority: Teachers use a 3N strategy to surround
spontaneous events with adult language.
• Enriched Caregiving: Teachers encourage children to
practice skills (e.g., cooperating, listening, counting,
colour recognition) during care routines.
All 4 elements of the Abecedarian Approach are shared with
parents through home visits and through carers in day care
Centre's from 1 to 3 years
Abecedarian studies
Long-term Health Results for
at risk Children with Abecedarian
• Fewer risky behaviors at age 18 (p<.05)
• Fewer symptoms of depression (p<.03) at age 21
• Healthier life styles. The odds of reporting an
active lifestyle in young adulthood were 3.92
times greater compared to the control group: if
there was a medicine that produced this odds
ratio all children would be on it!
McCormick, et al. 2006. Pediatrics.
McLaughlin. 2007. Child Development.
Campbell et al., 2008. Early Childhood Research Quarterly.
% of children in Normal IQ Range (>84)
by Age (longitudinal analysis)
Martin, Ramey, & Ramey. 1990. American Journal of Public Health
Stanford-Binet X Maternal Education
Ramey & Ramey. 1998. Preventive Medicine..
Educational Attainment:
Percent College Attendance
At age 21, almost three times as many
individuals in the treated group (39.5%)
compared to the control group (13.7%)
had attended, or were still attending,
a 4-year university.
χ2(1, N = 104) = 6.78, p < .01
Campbell et al., 2002. Applied Developmental Science.
Post-High School Education for Teen Mothers
Whose Children Were in the Abecedarian Program
Percent of Group
100
80
60
40
Preschool Intervention
Control
20
0
Entry
4 Years
Later
8 Years 15 Years
Later
Later
Ramey et al. 2000. Applied Developmental Science
Outcome for vulnerable children with 7 week
Abecedarian pre-school intervention
Once enrolled children stay enrolled
Ref: Early Learning & Development - The first five years determine a lifetime. Children Now
http://dev.childrennow.org.s78640.gridserver.com/index.php/learn/early_learning_and_develo
pment/
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